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Language Disorder
DSM-III In DSM-III, this category is called Developmental Language Disorder Disorders # Developmental Language Disorder, Expressive Type # Developmental Language Disorder, Receptive Type DSM-IV Disorders # Expressive Language Disorder # Mixed Receptive-Expressive Language Disorder Differential Diagnosis Another Language Disorder Expressive Language Disorder is distinguished from Mixed Receptive-Expressive Language Disorder by the presence in the latter of significant impairment in receptive language. Pervasive Developmental Disorders Expressive Language Disorder is not diagnosed if the criteria are met for Autistic Disorder or another Pervasive Developmental Disorder. Autistic Disorder also involves expressive language impairment but may be distinguished from Expressive and Mixed Receptive-Expressive Language Disorders by the characteristics of the communication impairment (e.g., stereotypes use of language) and by the presence of a qualitative impairment in social interaction and restricted, repetitive, and stereotyped patterns of behavior. Mental Retardation, sensory deficits, speech-motor deficits, and severe environmental deprivation Expressive and receptive language development may be impaired due to Mental Retardation, a hearing impairment or other sensory deficit, a speech-motor deficit, or severe environmental deprivation. The presence of these problems may be established by intelligence testing, audiometric testing, neurological testing, and history. If the language difficulties are in excess of those usually associated with these problems, a concurrent diagnosis of Expressive Language or Mixed Receptive-Expressive Language Disorder may be made. Children with expressive language delays due to environmental deprivation may show rapid gains once the environmental problems are ameliorated. Disorder of Written Expression In Disorder of Written Expression, there is a disturbance in writing skills. If deficits in oral expression are also present, an additional diagnosis of Expressive Language Disorder may be appropriate. Selective Mutism Selective Mutism involves limited expressive output that may mimic Expressive or Mixed Receptive-Expressive Language Disorder; careful history and observation are necessary to determine the presence of normal language in some settings. Acquired aphasia Acquired aphasia associated with a general medical condition in childhood is often transient. A diagnosis of Expressive Language Disorder is appropriate only if the language disturbance persists beyond the acute recovery period for the etiological general medical condition (e.g., head trauma, viral infection). DSM-5 Diagnostic Criteria A'''. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following: # Reduced vocabulary (word knowledge and use). # Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology). # Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation). '''B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination. C'''. Onset of symptoms is in the early developmental period. '''D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Differential Diagnosis Normal variations in language Language disorder needs to be distinguished from normal developmental variations, and this distinction may be difficult to make before 4 years of age. Regional, social, or cultural/ethnic variations of language (e.g., dialects) must be considered when an individual is being assessed for language impairment. Hearing or other sensory impairment Hearing impairment needs to be excluded as the primary cause of language difficulties. Language deficits may be associated with a hearing impairment, other sensory deficit, or a speech-motor deficit. When language deficits are in excess of those usually associated with these problems, a diagnosis of language disorder may be made. Intellectual disability (intellectual developmental disorder) Language delay is often the presenting feature of intellectual disability, and the definitive diagnosis may not be made until the child is able to complete standardized assessments. A separate diagnosis is not given unless the language deficits are clearly in excess of the intellectual limitations. Neurological disorders Language disorder can be acquired in association with neurological disorders, including epilepsy (e.g., acquired aphasia or Landau-Kleffner syndrome). Language regression Loss of speech and language as a child younger than 3 years may be a sign of autism spectrum disorder (with developmental regression) or a specific neurological condition, such as Landau-Kleffner syndrome. Among children older than 3 years, language loss may be a symptom of seizures, and a diagnostic assessment is necessary to exclude the presence of epilepsy (e.g., routine and sleep electroencephalogram).